Solid Stool Incontinence Research Articles

G.P.249: Frequency of multisystem abnormalities among Czech patients with myotonic dystrophy

Myotonic dystrophy (DM) is a multisystem disorder characterized by skeletal muscle and multiple organ impairment. The aim of the study is to compare our local data from the registry with that known in other countries. The data from the local part of Czech national registry of myotonic dystrophy including focused questionnaires were evaluated. The population consists of 107 patients: 28 DM type 1 mean age 42.6 (range, 23–63), 79 DM type 2 mean age 54.1 (range, 22–76); 67 females and 40 males. One of the most common complaints of patients was muscle pain. Long-term prevalence of muscle pain occurred in 63.6% of patients (71.4% of DM type 1 and 60.8% of DM type 2). Half of the patients (52.4%) suffered from excessive daytime sleepiness in varying degree of intensity. Cognitive dysfunction had 8.6% of our patients, but mostly in DM type 1. Diabetes mellitus or impaired glucose tolerance were found in 21.5% of patients and thyroid dysfunction in 17.4%. Increased sweating indicated 44.8% of patients. Dysphagia was found in 27.8% and 55.8% of patients had fecal incontinence (15.1% was never able to prevent the incontinence of loose stools and 29.1% was not able to prevent the incontinence of solid stool). More than half of the patients (51.2%) reported stress incontinence (during exercise, coughing or sneezing) and 41.9% have other various forms of the urinary incontinence. Our results are consistent with previously published data. We found surprisingly high frequency of bowel incontinence which was not so far comprehensively studied.

Development and validation of a scoring system for late anorectal side-effects in patients treated with radiotherapy for prostate cancer

PurposeTo develop and validate a scoring system for evaluation of long term anorectal dysfunction following radiotherapy for prostate cancer. Materials and methodsPatients treated for prostate cancer with radiotherapy filled in questionnaires on anorectal function and quality of life. Items for the condensed anorectal dysfunction score (RT-ARD) were identified and weighted by binomial regression analysis. The score was tested in a separate patient material by receiver operating characteristic (ROC) analysis and correlations to quality of life domains. ResultsA total of 309 patients participated in the study. The items selected were “incontinence for solid stool”, “ability to defer defecation”, “unproductive call to stool”, “clustering of stool”, and “mucus in stool.” Patients were grouped into three categories according to the RT-ARD score; 0–8 (no RT-ARD), 9–23 (minor RT-ARD), 24–45 (major RT-ARD). ROC analyses revealed high sensitivity (91%) and specificity (85%) for major RT-ARD. The prediction model demonstrated a perfect fit in 60%, moderate fit in 36% and no fit in 4%. There was good correlation between the RT-ARD score and quality of life. ConclusionsThe RT-ARD score is a validated and simple instrument for evaluation of anorectal dysfunction following radiotherapy for prostate cancer, and the RT-ARD score correlates to the patient’s quality of life.

Chronic Third and Fourth Degree Perineal Tear Following Obstetric Trauma- A Case Series

Chronic Third and Fourth Degree Perineal Tear Following Obstetric Trauma- A Case Series This is a study conducted on 6 cases of chronic perineal tear repaired at vydehi institute of medical sciences and research centre. The cases were analyzed with respect to risk factors, method of surgery and outcome after surgery. Results: Out of 6 cases studied 2 had incontinence for both watery stools and solid stools. Out of 6 cases studied 4 were incontinent only for watery stools and all were incontinent for flatus. Immediately following surgery all were continent for solid stools and 2 were incontinent for watery stools and flatus. At the end of 6 months all the patients were continent for solid and watery stools and only one patient was incontinent for flatus.

Persisting anorectal dysfunction after rectal cancer surgery

Sphincter-saving rectal cancer management affects anorectal function. This study evaluated persisting anorectal dysfunction and its impact on patients' well-being. Seventy-nine patients with a follow-up of 12-37 (median 22) months and 79 age- and sex-matched control subjects completed questionnaires. The median number of diurnal bowel movements was three in patients and one in controls (P < 0.0001). Nocturnal defaecation occurred in 53% of patients. The median Vaizey score was 8 in patients and 4 in controls (P < 0.0001). Urgency without incontinence was reported by 47% of patients and 49% of controls (P = 0.873), soiling by 28% of patients and 3% of controls (P < 0.0001), incontinence for flatus by 73% of patients and 49% of controls (P = 0.0019), and incontinence for solid stools by 16% of patients and 4% of controls (P = 0.0153). Incontinence of liquid stools occurred in 17 of 20 patients and in one of five controls who had liquid stools (P = 0.0123). Incontinence for gas, liquid or solid stool occurred once or more weekly in 47%, 19% and 6% of patients respectively. Evacuation difficulties were reported by 98% of patients, but also by 77% of controls. Neoadjuvant radio(chemo)therapy adversely affected defaecation frequency and continence. Incontinence was associated with severe discomfort in 50% of patients, severe anxiety in 40% and severe embarrassment in 48%. Anorectal dysfunction is a frequent problem after management of rectal cancer with an impact on the well-being of patients.

Complete Obstetric Anal Sphincter Tear and Risk of Long-term Fecal Incontinence

Women with anal sphincter injuries have an increased risk of developing fecal incontinence despite surgical intervention. The aim of this study was to evaluate the long-term risk of fecal incontinence after primary anal sphincter reconstruction and its impact on quality of life. This was a cohort study. This study was performed at Aarhus University Hospital. Women with complete anal sphincter rupture (exposed) from 1976 to 1991 and a control group of parous women (nonexposed) were included. The primary outcomes measured were fecal incontinence, Wexner score, St Mark incontinence score, and quality of life. A total of 363 women were included (125 exposed and 238 nonexposed). The mean age was 50.4 years (95%CI: 49.8-51.0), with 22.2 years (95% CI: 21.7-22.6) of follow-up. At the time of follow-up, 49% of exposed women and 74% of nonexposed women were continent. Complete anal sphincter tear increases the risk of fecal incontinence twofold (relative risk = 2.00; 95%CI: 1.52-2.63). No other risk factors were identified. The mean Wexner score was 1.7 (95%CI: 1.3-2.1) vs 1.1 (95%CI: 0.7-1.4) (p = 0.02), and the mean St Mark score was 2.8 (95% CI: 2.1-3.4) vs 1.4 (95%CI: 1.0-1.9) (p < 0.001) in the exposed and nonexposed groups. Severity of fecal incontinence had a significant impact on the quality of life independent of exposure. The cohort is relatively young; a short postmenopausal period limits the assessment of hormonal status and the effect of postmenopausal hormone replacement therapy. Complete obstetric anal sphincter tear increases the long-term risk of fecal incontinence twofold. When present, the severity of the incontinence symptoms is minor and the risk of incontinence for solid stool is not increased in comparison with the general population. Anal sphincter rupture is the only independent risk factor for fecal incontinence. The severity of fecal incontinence had the same impact on quality of life in both groups.

A novel animal model of long-term sustainable anal sphincter dysfunction

BackgroundAlthough intersphincteric resection can avoid the need for permanent colostomy in patients with lower rectal cancer, it sometimes causes anal sphincter dysfunction, thus resulting in a lifelong, debilitating disorder due to incontinence of solid and liquid stool. The development of regenerative medicine could improve this condition by regenerating impaired anal muscle. In order to prove this hypothesis, preliminary experiments in animals will be indispensable; however, an adequate animal model is currently lacking. The purpose of this study was to establish a novel animal model with long-term sustainable anal sphincter dysfunction. Materials and methodsTwenty male Sprague-Dawley rats were allocated into sham operation (n = 10) and anal sphincter resection (ASR) (n = 10) groups. The ASR group underwent removal of the left half of both the internal and external anal sphincters. Both groups were evaluated for anal function by measuring their resting pressure before surgery and on postoperative day (POD) 1, 7, 14, and 28. ResultsThe rats in the sham operation group recovered their anal pressure up to baseline on POD 7. The rats in the ASR group showed a significant decrease in anal pressure on POD 1 (P < 0.0001) compared with the baseline, and kept this low pressure until POD 28 (P < 0.0001). The defect of the anal sphincter muscle was confirmed histologically in the ASR group on POD 28. ConclusionsThe present novel model exhibits continuous anal sphincter dysfunction for at least 1 mo and may contribute to further studies evaluating the efficacy of therapies such as regenerative medicine.

Long‐term efficacy of dextranomer in stabilized hyaluronic acid (NASHA/Dx) for treatment of faecal incontinence

Randomized, controlled trials have demonstrated the efficacy and safety of injectable bulking agents for the treatment of faecal incontinence (FI), although the long-term outcome has not been assessed. NASHA/Dx gel, a biocompatible, nonallergenic bulking agent consisting of nonanimal stabilized hyaluronic acid and dextranomer microspheres, has demonstrated efficacy and safety for up to 12 months after treatment. The objective of this study was to evaluate the long-term efficacy and safety of NASHA/Dx, assessed 24 months after treatment. This study was a 24-month follow-up assessment of patients treated with NASHA/Dx under open-label conditions. Data on FI episodes and quality of life measures were collected from diaries over the 28-day period immediately preceding the 24-month assessment. Adverse events were collected. Eighty-three of 115 patients completed the 24-month follow-up assessment. At 24 months, 62.7% of patients were considered responders and experienced a ≥ 50% reduction in the total number of FI episodes. The median number of FI episodes declined by 68.8% (P < 0.001). Episodes of both solid and liquid stool incontinence decreased. The mean number of incontinence-free days increased from 14.6 at baseline to 21.7 at 24 months (P < 0.001). Incontinence scores and FI quality of life scores also showed significant improvements. The most common adverse events (AEs) were proctalgia (13.3%) and pyrexia (9.6%). The majority of AEs were mild to moderate, self-limited and resolved within 1 month of the injection. NASHA/Dx is safe, effective and durable over a 24-month period with a majority of patients experiencing significant improvement in multiple symptoms associated with FI.

Incontinence in full‐thickness rectal prolapse: low level of improvement after laparoscopic rectopexy

The study aimed to quantify incontinence before and after laparoscopic rectopexy in patients suffering from rectal prolapse. Eighty-five patients underwent laparoscopic rectopexy to treat rectal prolapse between 2003 and 2009. Symptomatic and functional data were collected prospectively before and after surgery by self-administered questionnaires including the Cleveland Clinic Fecal Incontinence Score (CCIS) and constipation, gastrointestinal quality of life and urinary incontinence questionnaires. Incontinence was considered to be present when the CCIS remained at ≥ 5 after surgery. After a mean follow-up period of 36 months after surgery, 83% of the patients reported good to excellent results. Continence was improved in 58 (68%), with a significant decrease in the continence score (-3.4 ± 5.8, P = 0.001). However, 50 (58.9%) patients remained incontinent: 47 (55%) reported urge incontinence and 27 (32%) had passive leakage. Incontinence for liquid stool, incontinence for solid stool and the need for protection was seen in 43 (51%), 35 (41%) and 43 (51%) patients. Manometry, defaecography and ultrasonography were not associated with any improvement. In contrast, the patients' average age (60.2 ± 15.8 vs 46.9 ± 15.5 years; P = 0.003), symptom duration before surgery (58.1 ± 70.1 vs 29.5 ± 33.3 months; P = 0.011), preoperative urinary incontinence score (10.7 ± 10.8 vs 4.2 ± 5.7; P = 0.0131) and faecal incontinence score (12.9 ± 4.9 vs 7.1 ± 6; P < 0.0001) were significantly higher in patients suffering from postoperative incontinence. Despite some continence improvement in two-thirds of patients who underwent surgery for rectal prolapse, the level of improvement remained low in more than half of the patients.

Outcomes and follow-up after obstetric anal sphincter injuries

To determine if the classification of obstetric anal sphincter injuries (OASIs) affected clinical and functional outcome and to assess the need for follow-up of 3a tears in secondary care Prospective data collection in 255 patients who sustained OASIs during repair with follow-up in a specialist clinic after 6 months. One hundred and thirty-two patients (51.7 %) sustained 3a tears, 81 (31.7 %) 3b tears, 27 (10.6 %) 3c tears and 15 (5.8 %) had 4th degree tears. Twenty-three patients (9 %) reported symptoms at 6-month follow-up. Eight patients reported anal incontinence of liquid or solid stool. Among patients who sustained 3a tears, 8 patients were symptomatic: 7 had urgency and 1 had flatus incontinence. None of the patients who sustained 3a tears reported incontinence of solid/liquid stool. There appears to be no correlation with scan findings and symptoms at follow up. Most patients are asymptomatic. Urgency of faeces is the commonest symptom. The vast majority of patients are asymptomatic. The necessity of seeing all these patients in secondary care for follow-up needs to be questioned. With effective primary care follow-up, there may be a place to follow up patients with 3a tears in the community during the routine 6-week postnatal check and refer the symptomatic patients to the hospital for further review.

Pelvic floor symptoms and bone mineral density in women undergoing osteoporosis evaluation

Our aim was to characterize pelvic floor symptoms in postmenopausal women who had undergone osteoporosis evaluation and examine their association with bone mineral density (BMD). Pelvic floor symptom questionnaires were mailed to 4,026 women. Multivariate logistic regression models controlling for age, race, body mass index (BMI), and chronic obstructive pulmonary disease (COPD) were performed comparing symptoms in women with osteoporosis (T score ≤ -2.5) and osteopenia (T score > -2.5 to < -1) at any site to women with normal BMD (T score: ≥ -1, referent). There were 1,774/4,026 (44%) questionnaires returned; 1,655 were included in the analysis (362 osteoporosis, 870 osteopenia, 423 normal BMD). Overall prevalence of any urinary incontinence (UI) was 1,226/1,640 (75%), with UI ≥2-3 times/week in 699/1,197 (58%), fecal incontinence over the past month in 247/1,549 (16%), and prolapse in 162/1,582 (10%). Multivariate analyses revealed that women with osteopenia had increased risk of incontinence of solid stool [adjusted odds ratio (aOR) 1.7, 95% confidence interval (CI) 1.1-2.4). Risk of UI ≥2-3 times/week was not increased in women with osteoporosis (aOR 0.9, CI 0.6-1.3) and was lower in women with osteopenia (aOR 0.7, CI 0.5-0.9). In women with osteoporosis, the odds of moderate- to large-volume urine loss versus small/none was higher for those in the lower T-score quartile (lower BMD; aOR 1.43, CI 1.1-1.9). In women undergoing osteoporosis evaluation, those with osteopenia were at increased risk of fecal incontinence but not UI compared with normal women. Osteoporotic women with the lowest T scores had higher risk of moderate- to large-volume UI. It is unclear whether there is a pathophysiologic link between BMD loss and development of pelvic floor symptoms.

Symptoms after obstetric sphincter injuries have little effect on quality of life

To compare the prevalence of anal incontinence and dyspareunia in women with or without obstetric sphincter injury after standardizing the suture technique. Retrospective case-control study. Regional hospital, Sweden. 305 women with an obstetric sphincter injury and 297 women with spontaneous vaginal delivery. In order to standardize and improve the repairing skills of sphincter injuries, collaboration between obstetricians and colorectal surgeons was begun in 2000. Inner and external sphincters were repaired in two layers with continuous monofilament polidioxane sutures. The participating women received a questionnaire with validated questions on anal incontinence, dyspareunia and quality of life. The follow-up time was 15 months to 8 years. Anal incontinence, dyspareunia and quality of life. Of the sphincter group, 72% returned the questionnaire, as did 67% in the control group. Significantly more women in the sphincter group suffered from incontinence of flatus and loose stool compared to controls (p < 0.05). There was no significant difference of incontinence of solid stool, soiling, or fecal urgency between the groups. The quality of life questions showed no significant difference between the groups. In the sphincter group, there was significantly more superficial coital pain compared to controls (p= 0.02). Significantly more women with complete sphincter injury reported anal incontinence than women with a partial sphincter injury. In spite of increased rate of anal incontinence and dyspareunia after anal sphincter rupture, there was no statistically significant reduction in the women's quality of life.

Risk Factors for Fecal Incontinence in Older Women

The objectives of this study were to estimate the prevalence of fecal incontinence (FI) in older women and examine associations between potential risk factors and prevalent FI. We conducted a cross-sectional study of prevalent FI in 64,559 women, aged 62-87 years, in the Nurses' Health Study. Since 1976, participants provided information on health and lifestyle on mailed biennial questionnaires. Data on FI were collected in 2008. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for FI were calculated using logistic regression models. The reported prevalence of liquid or solid stool incontinence at least monthly increased from 9% in women aged 62 to 64 years to 17% in women aged 85 to 87 years. Prevalent FI was 50% less common in black women compared with white women (6% vs. 12%, respectively). Other variables associated with increased odds of FI at least monthly were pregnancy, higher body mass index (BMI), lower physical activity, functional limitations, current cigarette smoking, type 2 diabetes, high blood pressure, and neurologic disease. Urinary incontinence (UI) was a strong correlate of FI, with 63% of women with FI reporting UI at least monthly compared with 45% of women in the whole study population. FI is a common condition among older women, and often co-occurs with UI. Potentially modifiable risk factors include BMI, physical activity, and cigarette smoking.

1879 ASSOCIATION OF PELVIC FLOOR SYMPTOMS AND BONE MINERAL DENSITY IN WOMEN PRESENTING FOR OSTEOPOROSIS EVALUATION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology II1 Apr 20121879 ASSOCIATION OF PELVIC FLOOR SYMPTOMS AND BONE MINERAL DENSITY IN WOMEN PRESENTING FOR OSTEOPOROSIS EVALUATION Holly Richter, PhD, MD Sarah Morgan, MD Jonathan Gleason, MD Ligong Chen, PhD Jeffrey Szychowski, PhD Patricia Goode, MD Alice Howell, andRN, BSN, CCRC Kathryn BurgioPhD Holly RichterHolly Richter Birmingham, AL More articles by this author , Sarah MorganSarah Morgan Birmingham, AL More articles by this author , Jonathan GleasonJonathan Gleason Birmingham, AL More articles by this author , Ligong ChenLigong Chen Birmingham, AL More articles by this author , Jeffrey SzychowskiJeffrey Szychowski Birmingham, AL More articles by this author , Patricia GoodePatricia Goode Birmingham, AL More articles by this author , Alice HowellAlice Howell Birmingham, AL More articles by this author , and Kathryn BurgioKathryn Burgio Birmingham, AL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2033AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Connective tissue and other extracellular matrix abnormalities are associated with the development of pelvic floor disorders including incontinence (urinary and fecal) and pelvic organ prolapse in women. Low bone mineral density (BMD) also reflects deficits in bone connective tissue qualities including mass, matrix and microarchitectural abnormalities. Pelvic floor symptoms were characterized in post-menopausal women presenting for evaluation to an Osteoporosis Clinic. METHODS Validated pelvic floor symptom questionnaires were mailed to patients in an IRB-approved osteoporosis database (January, 2007-October, 2010). Questions assessed urinary incontinence (UI) in the past 3 months, UI frequency and severity, incontinence of liquid/solid stool over the past month, and bothersome prolapse symptoms. Multivariable logistic regression models controlling for age, race, body mass index, and COPD were performed to compare symptoms in women with osteopenia (T-score <−1 to >−2.5) and osteoporosis at any site (T-score: ≤−2.5) to women with normal BMD (T-score: ≥−1, referent). RESULTS 1774/4026 (44%) questionnaires were returned. 1655 postmenopausal women with BMD diagnoses were included in the analyses (423 normal BMD, 870 osteopenia, 362 osteoporosis). Mean (±SD) age was 63(±9) years. Overall prevalence of UI was 1226 (75%) with UI frequency ≥2-3 times/week in 699 (58%), fecal incontinence in 247 (16%), and bothersome prolapse symptoms in 162 (10%). Prevalence of prolapse symptoms did not differ by BMD group (p=0.87). Multivariable analyses revealed that women with osteoporosis had increased risk of incontinence of solid stool (OR: 1.8, 95% CI: 1.2-2.8) as compared to women with normal BMD. Risk of UI ≥2-3 times/week was not increased in women with osteoporosis (OR: 0.9, 95% CI: 0.6, 1.3) and was lower in women with osteopenia (OR: 0.7, 95% CI: 0.5-0.9). Multivariable analysis in the subset of women with osteoporosis revealed that the odds of moderate/large volume urine loss vs small/none was higher for lowest T-score quartile (lower BMD), OR: 1.42, 95% CI: 1.08-1.88. CONCLUSIONS In a cohort of women undergoing BMD evaluation, those with osteoporosis were at increased risk of solid stool incontinence, but not UI. Women with osteoporosis and lowest quartile T-scores (lowest BMD) had an increased risk of moderate/large volume UI. Further studies should target the evaluation of connective tissue markers and pathological mechanisms linking low BMD and pelvic floor symptoms. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e759 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Holly Richter Birmingham, AL More articles by this author Sarah Morgan Birmingham, AL More articles by this author Jonathan Gleason Birmingham, AL More articles by this author Ligong Chen Birmingham, AL More articles by this author Jeffrey Szychowski Birmingham, AL More articles by this author Patricia Goode Birmingham, AL More articles by this author Alice Howell Birmingham, AL More articles by this author Kathryn Burgio Birmingham, AL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prevalence of bowel dysfunction in colorectal cancer survivors.

638 Background: There is limited research on the long-term bowel health outcomes of colorectal cancer (CRC) survivors even though colorectal surgery, radiation, and chemotherapy can pose significant morbidity for patients. Our aims were to characterize the prevalence of specific bowel complications in CRC survivors and to compare their outcomes with those of non-CRC survivors and non-cancer controls. Methods: Using population-based data from the 2009 U.S. National Health and Nutrition Examination Survey, we identified 3 different groups of adult patients: CRC survivors, non-CRC survivors, and non-cancer controls. Weighted multivariate logistic regression models were constructed to determine the relationship between survivor status and bowel health outcomes, while controlling for patient and disease characteristics. Main outcomes included leakage of gas, mucus, liquid stool, and solid stool. Stratified analyses were subsequently conducted to assess for effect modification based on gender (men vs. women), age (≤ 60 vs. &gt;60), and ethnicity (white vs. non-white). Results: In total, 10,894 subjects were included: 75 CRC survivors, 910 non-CRC survivors, and 9909 non-cancer controls. Baseline characteristics were similar among all 3 patient groups. In univariate analyses, more CRC survivors reported bowel dysfunction, including leakage of: gas (15 vs. 12 vs. 10%, p=0.01), liquid stool (8 vs. 7 vs. 4%, p&lt;0.001), and solid stool (2 vs. 0 vs. 0%, p&lt;0.001) than non-CRC survivors and non-cancer controls. In multivariate analyses, CRC survivors continued to have significantly higher odds of solid stool incontinence (OR 2.09, 95% CI 1.24-3.53, p&lt;0.05) when compared to the other groups. The association between surviving CRC and presence of bowel dysfunction was not modified by ethnicity, but specific outcomes, such as solid stool leakage, were more prominent in women (p=0.003) and those who were aged &gt;60 years (p=0.002). Conclusions: Bowel problems are significantly more frequent among CRC survivors than non-CRC survivors and non-cancer patients, especially for women and the elderly. Studies to develop interventions that minimize these bowel complications are needed in order to improve the long-term health and quality of life for CRC survivors.

Menopause and Obstetric History as Risk Factors for Fecal Incontinence in Women

Fecal incontinence is a highly prevalent condition, especially in women. However, few data on prevalence in women attending primary care are available, particularly regarding the presence of risk factors. The aim of this study was to determine characteristics of women with fecal incontinence and to analyze obstetric history and menopause as potential risk factors. Observational study with a cross-sectional design. Patients in primary care at 10 health care centers in Barcelona, Spain. Fecal incontinence was defined as loss of flatus or liquid/solid stool occurring at least monthly. Data on the following variables were collected by face-to-face interviews and patient questionnaires: demographic and clinical characteristics, obstetric history, menopause data, fecal incontinence, and quality of life. Univariable and multivariable analyses were performed to study the association of potential risk factors with fecal incontinence. The study included 332 women with a mean age of 60.8 (SD, 17.8) years. The prevalence of fecal incontinence was 12.0% (40/332). Flatus incontinence was reported in 27 patients (67.5%), liquid stool incontinence in 25 (62.5%), and solid stool incontinence in (19) 47.5%. On multivariable analysis, the only independent risk factors for fecal incontinence were an obstetric history of complicated deliveries (instrumentation or podalic presentation; OR, 3.66; 95% CI, 1.54-8.68, P = .003) and menopause (OR, 5.67; 95% CI, 1.35-23.78; P = .018). The cross-sectional design hampered identification of the time at which the impact of menopausal status occurred, and data obtained from patient interviews was subject to recall bias. Complicated deliveries are risk factors for fecal incontinence in women. Fecal incontinence appears to be more prevalent in menopausal women.

Haemorrhoids, constipation and faecal incontinence: is there any relationship?

Little is known about the association of haemorrhoids and anorectal function. Moreover, available data on the impact of constipation on the presence of haemorrhoids are conflicting. The present study aimed to assess any potential relationship between haemorrhoids and anorectal dysfunction. All participants who attended the Austrian nationwide healthcare programme for colorectal cancer screening at four medical institutions were enrolled prospectively between 2008 and 2009. A colonoscopy and detailed anorectal examination were performed on all patients. Haemorrhoids were classified according to an international grading system. Faecal incontinence was defined as the involuntary loss of solid stool, liquid stool or gas, at least once a month. Constipation was recorded by a constipation scoring system. Of 976 participants, 380 (38.9%) were found to have haemorrhoids. There was an association between healthy individuals, patients with symptomatic and patients with asymptomatic haemorrhoids and incontinence of liquid stool. No association was found regarding incontinence for solid stool and gas. The median constipation score was significantly higher in those patients with haemorrhoids (grade I-IV) compared with patients without haemorrhoids (2.5 points (range, 0-19) and 3 points (range, 0-19); P = 0.0113). 'Painful evacuation effort' and 'assistance for defaecation (stimulant laxatives, digital assistance or enema)' showed a significant correlation with haemorrhoids (P = 0.0394 and P = 0.0143). Although the median constipation score was low in both groups, there was a significant association between constipation and haemorrhoids in adult patients.

Urinary and Fecal Incontinence After Bariatric Surgery

Morbidly obese women have markedly high rates of urinary and fecal incontinence. Weight loss reduces prevalence and severity of urinary incontinence; however, the effect of weight loss on fecal incontinence is unknown. The aim of this study was to document the prevalence of urinary and fecal incontinence in subjects who underwent bariatric surgery and associated weight loss. We mailed a detailed survey to all 404 adults who underwent bariatric surgery at the University of Wisconsin prior to May 2006. Type and severity of urinary and fecal incontinence was obtained using previously validated questionnaires. Perceived effect of surgery on bowel and bladder function was also assessed. Forty-eight percent (193) of the surveys were returned. Urinary incontinence was reported in 72% of the women, 39% of whom perceived improvement after surgery. Only 21% of the men reported urinary incontinence. In contrast, fecal incontinence was common in both men and women; 48% of the women and 42% of the men reported liquid stool incontinence and 21% of the women and 30% of the men reported solid stool incontinence. Fifty-five percent of the women and 31% of the men with fecal incontinence perceived worsening after surgery. Women with diarrhea were four times more likely to report fecal incontinence (P<0.0001). Furthermore, women who perceived worsening of diarrhea after surgery were significantly more likely to have fecal incontinence (P=0.003). Both fecal and urinary incontinence were common after bariatric surgery. Risk factors for fecal incontinence in women after bariatric surgery include diarrhea and worsening of diarrhea; we suggest that such surgery may uncover prior weaknesses in the continence mechanism.

Defects on endoanal ultrasound and anal incontinence after primary repair of fourth‐degree anal sphincter rupture: a study of the anal sphincter complex and puborectal muscle

To perform three-dimensional endoanal ultrasound (EAUS) after primary repair of fourth-degree anal sphincter rupture (ASR) and correlate the sonographic defects with anal incontinence (AI); to measure the axial and sagittal thickness and angle of the puborectal muscle (PRM) as well as the length of the anal canal, and then correlate these measures with AI; and to assess the interobserver measurement agreement between an inexperienced and an experienced sonologist. EAUS was offered to 84 consecutive women, who were asked to answer a validated questionnaire after fourth-degree ASR. AI was graded according to the Wexner score and EAUS defects were graded according to the Starck score. Sixty-one women (73%) answered the questionnaire. The median (range) follow-up time was 5.1 (1.3-8.7) years. Thirty-three (54%) of these women underwent EAUS and were included in the study. There was no difference in the incontinence scores between women who underwent EAUS and those who did not. Eleven of the women who underwent EAUS (33%) were continent, 22 women (67%) had flatus incontinence at least once a month, of whom 12 also had incontinence for liquid stool and two had incontinence for solid stool. The median Wexner score was 2 (range, 0-12). Five of the patients (15%) had no ultrasound defects. All of the patients with Wexner scores > or = 4 had a Starck score of > or = 10. No association between ultrasound defects and AI was demonstrated, however, the angle of the PRM and parity were associated with Starck score. No clear association between the measurements of the PRM and AI was shown. The experienced observer detected more of the small defects than did the inexperienced observer. In a 1-9-year follow-up period after primary suture of fourth-degree ASR, the frequency of AI was high, at 67%. No clear association was seen between AI and sphincter defects detected on ultrasonography. There was an association between the angle of the PRM and the extent of ultrasound defects.

Colorectal and anal symptoms in women with urinary incontinence and pelvic organ prolapse

Our aim was to determine the prevalence of colorectal and anal (CRA) symptoms in women with urinary incontinence and pelvic organ prolapse (UI/POP) in a predominantly Latina population. We reviewed charts of women seen in the urogynecology clinic for UI/POP for those who completed the colorectal anal distress inventory-8 (CRADI-8) on their first visit. A detailed history was taken independent of the questionnaire. Two hundred sixty-five women completed the questionnaire; 94% were Latina; 89% completed the questionnaire in Spanish. Of the women, 88% indicated at least one CRA symptom: 60% reported needing to strain hard to have a bowel movement; 59% reported sensation of incomplete bowel emptying; 21% indicated incontinence of solid or liquid stool, and an additional 30% of women reported flatal incontinence only, for a total anal incontinence rate of 58%. CRA symptoms are highly prevalent among women with UI/POP who completed the CRADI-8 in a predominantly Latina patient population.

Prevalence of double incontinence, risks and influence on quality of life in a general female population

Urinary incontinence (UI) and anal incontinence (AI) are complaints with impact on quality of life (QOL). Few data are available on prevalence of double incontinence (DI) in the general female population. To determine prevalence of UI, AI, and DI, their associations with age, parity, and effects on QOL. Cross-sectional study on a general female population, aged 45-85 years. Validated questionnaires measuring pelvic floor dysfunction and QOL. A short questionnaire was used for non-responders. Analyses were performed with Chi-square tests, ANOVA, and logistic regression. Response rate was 62.7% (1,869/2,979); 59% of non-responders filled in the short questionnaire (620/1,051). No significant differences in stress urinary incontinence, vaginal bulging, solid stool incontinence and parity were found between responders and non-responders. DI with and without flatal incontinence were reported by 7.7% and 35.4%, respectively. Women with urge urinary incontinence (UUI) alone had an OR of 4.3 (95% CI 2.4-7.9) for liquid stool incontinence, 1.6 (95% CI 0.5-4.9) for solid stool incontinence and 2.4 for flatal incontinence (95% CI 1.5-3.8). Women with AI had an OR of 5.8 (95% CI 1.8-18.2) for UUI. Women with DI including flatus reported significantly poorer QOL. Limitation of the study was the lack of objective clinical validation of symptoms, which may have influenced the real prevalence data. Most important relation was found between UUI and liquid stool incontinence (OR 4.3). We recommend that clinicians take the history of patients with UUI or mixed urinary incontinence to exclude the co-existence of AI.